Three Dimensions of Hospital Performance (Part 3: KPIs)

by Raf Cammarano, 26 April 2018

Part 1 of this series explained the three dimensions of hospital performance, and Part 2 explained that the dimensions are related, that adjusting performance in one dimension, will have flow-on consequences for the other two.

This post talks about the key performance indicators (KPIs) that can be used to measure the performance of each of the three dimensions. The KPIs are illustrated here:

The data in a Hospital Information System (HIS) plays a central role in generating the KPIs for these three dimensions. A hospital will have other systems, most notably Finance and HR, which also contain valuable KPI data. However, a HIS is uniquely positioned to allow management to balance the three interrelated dimensions because the HIS is the only one that works at the patient-level. Data is not aggregated at the service, department or hospital level. This granularity allows management to create actionable KPIs.

The following KPIs are provided as examples only. Every management team will need to decide on their own KPIs and provide unambigous definitions for each of them, definitions which makes sense their staff.

It should also be noted that some KPIs can fit into multiple categories. For example, the 'Readmission Rate' can either be a measure of the quality of care (re-admissions should be close to zero), or it could be a measure of access since the expected readmission rate should be taken into account when deciding how many new admissions should be accepted.

These **Staff** KPIs relate specifically to a HIS. Additional KPIs can be pulled from the HR System. KPIs from a HIS relate to the utilisation/mix of staff used for direct patient care. That's information that does not exist in the HR System. All things being equal, you want to match staff qualifications, experience and skills to the clinical task being performed (e.g. the chief surgeon does not need to do all bedside consults, an junior nurse can take and record observations). Examples:

The **Charge Capture** KPIs relate to making sure that all services performed can be attributed to the patient that received those services. For example, if a pathology test is not correctly attributed to the patient, that pathology test will not be invoiced and the hospital has effectively performed the service for free. Examples:

The **Claiming** KPIs relate to how well the hospital claims benefits from the government or the patient's insurer. Invoicing and claiming could be done from a separate finance or claiming system (assuming that hospitals decide to claim on patient's behalf rather than invoicing the full amount and asking patients to seem reimbursements). But if claiming is done from the HIS then the following KPIs should be considered:

- Claim Submission Time- Claims Denied or Reduced- Deposits Taken on Admission- Payments Made At Discharge

Raf Cammarano

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